I said I would tell you about my "anaesthetist" (& other stories)

January 18^th

 

I have now survived 4-nights on call and recon that I am probably about half way through my stint as the solo obstetrician and gynaecologist here (although the exact date and time of Tekle's return will be known only when I see him). Thankfully it is much quieter here than other places I have worked albeit the problems I see are much more extreme and everyone is well aware that on a 1:1 shift it is important that there are rest times.

Things also happen quickly, in that the decision about what to do next is obvious by the time a woman arrives on the labour ward here and so we are able to move swiftly into action. And when I say swiftly I mean exactly that, if I recommend a caesarean section (I could say order as there seems to be no question of anyone disagreeing with my recommendation) then the nurse midwife takes the consent (signature or more commonly a thumb-print), does the needful pre-op bits and wheels down to theatre (know as the "OR" as American terminology seems to have gained the upper hand). In theatre the team will be waiting and we will be ready to start within a very short time. All this is a far cry from the UK where at every stage there is massive discussion, coercion and even begging required to get anything to happen especially if you want it done quickly. The result of the speed here is that I can be called from my bungalow, see and assess a woman, do the caesarean, write notes and be back in my bungalow in only a little over an hour!

The only delay is if the surgeon is doing an emergency case as there is only one theatre. The level of workload is such that this doesn't happen very often. I did have to wait last night as they were patching up a guy involved in a stabbing incident (unfortunately the other protagonist was beyond the help of any hospital). It occurred to me that Gimbi on a weekend night is not dissimilar to Peckham as stabbings are the things that sometimes prevent caesareans (albeit in a second theatre) happening back home in King's.

There is no anaesthetist doctor in the hospital and an anaesthetic nurse gives all anaesthetics. He works 1:1 as well and has an even tougher deal than the on-call surgeon and myself as he covers both the emergency obstetrics, surgery and gynaecology as well as doing any elective operations that are required. Through all this he remains good-humoured and quite amazingly competent. So far he hasn't failed on any of the spinal blocks he has given for me which have all been rapidly highly effective with the woman apparently completely pain free. I have also done a few cases with Ketamine (a drug with many uses including as a Field anaesthetic in the army and more famously as a drug abused recreationally) for an anaesthetic. He can also administers general anaesthetics but I have not needed this so far. The latter is something I will try to avoid, as although his technical skills are fantastic I am not sure there is a great understanding of underlying physiology and so if things start to go wrong, the outcome might not be good.